Provider Demographics
NPI:1639171283
Name:MAENDEL, EBERHARD JOHANNES (PA-C)
Entity Type:Individual
Prefix:
First Name:EBERHARD
Middle Name:JOHANNES
Last Name:MAENDEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:630 S RANCHO DR
Practice Address - Street 2:SUITE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4873
Practice Address - Country:US
Practice Address - Phone:702-258-1001
Practice Address - Fax:702-258-3455
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00436130OtherRAILROAD MEDICARE PTAN
NVP00852334OtherRR MEDICARE NV 10/2010
NVP00852334OtherRR MEDICARE NV 10/2010
NV102625Medicare PIN
NVP00436130OtherRAILROAD MEDICARE PTAN